Abstract
Background
Increasing computed tomography (CT) and magnetic resonance imaging (MRI) use in the
emergency department (ED) over the last decade is well documented.
Objective
Our aim was to assess the impact of an electronic decision support and risk education
system (DS-RES) on CT/MRI use.
Methods
We conducted an age-, sex-, and risk-adjusted analysis of CT/MRI use and ED and inpatient
rebound rates before and after implementation in 2009 at a Kaiser Permanente Northwest
medical center.
Results
In the pre period, a total of 12,531 encounters occurred for unique patients within
each of 10 chief complaint categories. In the post period, 16,864 total encounters
occurred for unique patients within each chief complaint category, 11.4% of patients
were at low risk and 24.8% and 63.8% were at medium and high risk, respectively. Adjusted
CT/MRI use increased 1.1% (95% confidence interval [CI] 0%–2.3%) between pre and post
periods. Among low-risk and medium-risk patients, CT/MRI use decreased by 5.0% (95%
CI 2.5%–7.5%) and 10.4% (95% CI 7.9%–12.8%). Among patients at high risk, CT/MRI use
increased by 3.9% (95% CI 2.5%–5.3%). The proportion of patients with a 3- or 7-day
rebound to the ED or an inpatient facility decreased between pre and post periods
by 1.4% (95% CI 0.7%–2.2%) and 0.7% (95% CI 0.2%–1.5%).
Conclusions
DS-RES implementation did not decrease overall CT/MRI rates, but it was associated
with a shift in use toward high-risk patients and less patient rebound to the ED and
hospital. Further research is required to identify mechanisms underlying imaging utilization
shifts.
Keywords
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Article info
Publication history
Published online: October 07, 2014
Accepted:
July 1,
2014
Received in revised form:
May 29,
2014
Received:
August 28,
2013
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
